Our long-term goal is to improve the oral health and reduce disparities of children in Hawai'i. We hypothesize that the reach, and impact, of effective school-based caries prevention programs can be quantitatively increased by leveraging social networks to target behavioral change. 1. Significance: 10 million children (>20%) of U.S. elementary school age children have untreated dental decay. The disparity in health is notable, rising to 72% for American Indians/Native Americans. Effective school-based preventions are available but underutilized or unavailable. In Hawai'i there are: an abundance of dentists, but few accepting Medicaid;caries rates exceeding national averages;and no school-based caries prevention programs. 2. Innovation:Integrating social network analysis, behavior change and caries prevention has not before been attempted. If successful, a state-wide caries prevention could facilitate exceeding the goals of Healthy People 2020 prior to 2020. 3. Approach: Generate MOP and preliminary data. The specific aims are to: Create a manual of procedures (MOP) for pilot program, based on the NIDCR model, and modified from the PI's current successful, but independent, programs focusing social network analysis, behavioral change, and caries prevention. Carry out pilot program to generate and analyze preliminary data, working with two after school organizations. We will determine the social network and behavioral intent of all site coordinators (~100), and both parents and children in 4 pilot schools (~400 parents and children). Two sets of school's directors, parents, and children will receive targeted behavior change (experimental);the other two sets will receive no behavior change (control). Children in all four schools will receive comprehensive caries prevention. The primary outcome will be program impact, defined by RE-AIM. Prepare U01 application. We will use outcomes, RE-Aim, Markov Chain/Monte Carlo modeling, economic assessments, and power calculations to generate predictive models. These will allow us to revise the MOP and prepare a U01 application for implementation across the Hawai'ian Islands. 4. Investigators: Four experts in unique content areas will collaborate in this team science program, coordinating expertise in social network analysis, behavioral intent and change, caries prevention, and statistical and economic analysis. 5. Environment: Hawai'i is a small state with substantial health care needs and no school-based caries prevention program. The proposed program therefore coalesces an environment with high need, and investigators from institutions with extraordinary depth. PUBLIC HEALTH RELEVANCE: To improve the oral health and reduce disparities of children in Hawaii, we will implement an effective school-based caries prevention program that leverages social networks to effect social change.